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Home My WebLink AboutMINUTES - 01162007 - C.5 (17) z CLAiNI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY e ew4r BOARD ACTION: JANUARY 16 , 2007 Claim Against the County, or District Govemed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Sectiont t ) The copy of this document mailed to California Government Codes � you is your notice of the action taken 1!!1'2 2006 � on your claim by the Board of Supervisors. (Paragraph IV below), COUNTY COUNSEL given Pursuant to Government Code MARTINEZ CALIF. AMOUNT: THIS CASE WOULD LIE IN THE Section 913 and 915.4. Please note all SUPERIOR COURT, UNLIMITED Warnings". CLAIMANT: JURISDICTION =--MARITZA RENTERIA ATTORNEY6diLLIAM L. ' BERG; Esq . DATE RECEIVED: DECEMBER 12 , 2006 - ADDRESS: 2440 SANTA CLARA AVENUtEY DELIVERY TO CLERK ON: DECEMBER 12 , 2006 ALAMEDA, CA 94501 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN CULLEN, er Dated: DECEMBER 12 , 2006 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of S ervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: t --2 44/ d By: /WCf��Qeputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV BOARD ORDER: By unanimous vote of the Supervisors present: (� This Claim is rejected in full. O Other: I certify that this is a true and con-ect copy of the Board's Order entered in its minutes for this date. Date&h,yl+eaY OHN CULLEN, CLERK, By Deputy Clerk Ac WARNING ( . code section 913) Subject to certain exceptions,you have only six(6) nionths from the date this notice was personally seined or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in connection with this matter. if you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of Hiis Notice. AFFIDAVIT OF MAILING I declare under penalty of per jury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. DatedVA"semis' /? 10 JOHN CULLEN, CLERK By Deputy Clerk 12/06/2006 10:59 CONTRR COSTR COUNTY CLERK OF THE 4 915105238851 NO.850 D01 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLATMAN A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall. be presented not latex thansix months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action- (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. if claim is against a district governed by the Board of Supervisors, rather than the County, the i name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form- raaaarwaaa�aaaaaaa�a■sass■rasa sassrare■raaaararaas as aepee aaaaaao■aaaaN■.aNEW.f RL: Claim By: Reserved for Clerk's filing stamp Maritza Renteria ) RECEIVED Against the County of Contra Costa or ) DEC 1 2 2006 District) CLERK BOARD OF SUPERVISORS (Fill,in the naive) ) CONTRACOSTACO. The undersigned claimant hereby makes Claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: This case would lie in the Superior Court, Unlimited Jurisdiction. 1. When did the damage or injury occur? (Give exact date and hour) July 3, 2006, about 7:00 - 7:05 PM. 2, Where did the damage or injury occur? (Include city and county) Richmond Health Center, 100 28th Street, Richmond, California. 3. How did the damage or injury occur'? (Give full details;use extra paper if required) Ms. Renteria was at the Richmond Health Center for an evening appointment. Janitors were cleaning the building , and had made the floor excessively wet and slippery. 4, What particular act or omission on the part of county or district officers, servants, or employees caused the irxjury or damage? The County's servants/employees caused the floor to be excessively wet and slippery, and failed to place warning cones or signs. 5 What are the names of county or district officers, servants,or employees causing the damage or injury? Not Known. 12/08/2006 10:59 CONTRA COSTA COUNTY CLERK OF THE 4 915105238851 N0.850 D02 6, What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Fractured left knee cap, bruises and contusions, and emotional distress. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Medical records and bills are still being compiled. This case would lie in the Superior Court, Unlimited Jurisdiction. j i 8. Names and addresses of witnesses, doctors, and hospitals: No known witnesses. Claimant treated at the Richmond Health Center and Contra Costa Health Services. 9. List the expenditures you made on account of this accident or injury: DATE TIME AMOUNT Medical records and bills are still being compiled at this time. 4,-f IUrrr= ) Gprovides "The claim shall be sit or by some person on his be SEND NOTICES TO: (Attorney) ) Name and address of Attorney ) William L. Berg, Esq. ) 2440 Santa Clara Avenue . (Claimant's Signature) b(n�y of Qglftal-)1 ) Alameda, CA 94501 } 1415 Visalia Avenue (Address) Richmond, CA 94805 ) Telephone No. (510) 523-3200 )Telephone No. (510) 965-9713 •rrsssrrsrsrsssrssrrssrrsrrrsssrrssrrssrsar•s■rsr■■■r•■rr■■■rrrs■■rrrrasssrrsrsrrsr■■ PUBLIC RECORDS NOTICE: Please be advised that this claim 'form, or any elaini filed with the County under the Tort Claims Act, is subject to public diSClostnre under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records,are also subject to public disclosure. r�rrr�ll�r•■�srr■rrrrr■rr■•■rrr■■rrrr.rNOTICE rTr.�rrrrrrrrrrrrrrrrrrr�rrrrr r■rrrrrrrrrrr.■rrr6 J,O A ICE Section 72 of the Penal Code provides: Every person who, with intent:to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, accoLrnt vouClior, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by,imprisonment in the stage prison, by a line of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine.